CDL Driver Application

Commercial CDL Route Drivers

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Commerical CDL Route Driver Application

Name:

Phone:

Email:

Address:

Date of Birth:

Position Most Interested In:

How Did You Hear About The Position?

Rate of Pay Expected:

Have You Ever Worked For Hilltopper Before?

If So: When & Position Held

Do You Know Anyone That Is Currently Employed By Hilltopper? - If So, Who?

Are You Currently Employed?

If So, Who Are You Currently Working For?

EDUCATION

Education - Grade School:

Last School Attended:

MILITARY EXPERIENCE

Are You A Military Vet?

If Yes, Which Branch of Service?

GENERAL

Have You Ever Been Bonded?

If Yes, Name of Bonding Company:

Have You Ever Been Convicted of a Felony?

If Yes, Please Explain Conviction -- Conviction DOES NOT Mean Withdrawl From Position

PHYSICAL HISTORY

The Federal Motor Carier Safety Regulations (49CFR391 Subpart E) requires that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.

Date of Last DOT Examination:

Can You Provide a Copy of This Exam?

Have You Ever Been Granted a Waiver Under Section 391.49 of the Federal Motor Carrier Safety Regulations Pertaining to the Loss of Foot, Leg, Hand or Arm?

ALCOHOL AND CONTROLLED SUBSTANCE STATEMENT

Free Text

The Federal Motor Safety Regulations 49CFR40.25 (j) requires all persons with applying for a driving position requiring a commercial driver's license to answer the following questions:

Within the last 2 years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?

Within the last 2 years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you preformed safety-sensitive transportation work?

If you answered yes to either 1 or 2 above, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?

DRIVER'S LICENSE INFORMATION

Class D Driver Licenses Info -- Please Include: State Issued, License # and Expiration Date

A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

B. Has any license, permit or privilege ever been suspended or revoked?

C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

If you answered "Yes" to A, B, or C please explain why:

DRIVING EXPERIENCE

Class of Equipment:

Straight Truck
Tractor and Semi- Trailer
Twin
Other

Type of Equipment

Dates

Approximate Total Miles

List states operated in during the last five years

List any special courses or training that will help you as a driver

List safe driving awards held and who awards were presented by

Free Text

ACCIDENT HISTORY

Past Accidents/Incidents: Nature of accident, # fatalities, #injuries, # vehicles towed, citation issued for the past 3 years.

Traffic Convictions and Forefeitures for the past 3 years other than parking violations. (Please provide Date, Location, Charge, Penalty):

EMPLOYMENT RECORD

The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commerical vehicle list all employment for the last three (3) years. In addition, if you have driven a commerical vehicle previously, you must provide employment history for an additional seven (7) years for a total of ten (10) years. Any gaps in employment must be explained.

Start with your last or current position, including any military experience and work back. You are required to list the complete mailing address, street number, city, state, and zip code.

Current Employer:

Supervisor's Name:

Address:

Phone:

Position Held:

From:

To:

Salary:

Reason for Leaving:

Previous Employer:

Supervisor's Name:

Address:

Phone:

Position Held:

From:

To:

Salary

Reason for Leaving:

Previous Employer:

Supervisor's Name:

Address:

Phone:

Position Held:

From:

To:

Salary

Reason for Leaving

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of conern to applicant's record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508

Date:

Name: